Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
Department of Oncological and Emergency Surgery, Policlinico Casilino, Rome, Italy.
J Hepatobiliary Pancreat Sci. 2022 Jan;29(1):51-65. doi: 10.1002/jhbp.908. Epub 2021 Feb 23.
The Glissonean approach has been widely validated for both open and minimally invasive anatomic liver resection (MIALR). However, the possible advantages compared to the conventional hilar approach are still under debate. The aim of this systematic review was to evaluate the application of the Glissonean approach in MIALR.
A systematic review of the literature was conducted on PubMed and Ichushi databases. Articles written in English or Japanese were included. From 2,390 English manuscripts evaluated by title and abstract, 43 were included. Additionally, 23 out of 463 Japanese manuscripts were selected. Duplicates were removed, including the most recent manuscript.
The Glissonean approach is reported for both major and minor MIALR. The 1st, 2nd and 3rd order divisions of both right and left portal pedicles can be reached following defined anatomical landmarks. Compared to the conventional hilar approach, the Glissonean approach is associated with shorter operative time, lower blood loss, and better peri-operative outcomes.
Glissonean approach is safe and feasible for MIALR with several reported advantages compared to the conventional hilar approach. Clear knowledge of Laennec's capsule anatomy is necessary and serves as a guide for the dissection. However, the best surgical approach to be performed depends on surgeon experience and patients' characteristics. Standardization of the Glissonean approach for MIALR is important.
Glisson 入路已广泛应用于开放和微创解剖性肝切除术（MIALR）。然而，与传统肝门入路相比，其可能具有的优势仍存在争议。本系统评价旨在评估 Glisson 入路在 MIALR 中的应用。
在 PubMed 和 Ichushi 数据库中进行了文献系统评价。纳入英文或日文文章。从 2390 篇经标题和摘要评估的英文文献中，纳入 43 篇。此外，还选择了 463 篇日文文献中的 23 篇。去除重复文献，包括最新文献。
Glisson 入路适用于主要和次要 MIALR。根据明确的解剖标志，可以到达左右门静脉蒂的 1 、 2 和 3 级分支。与传统肝门入路相比，Glisson 入路具有手术时间更短、出血量更少和围手术期结果更好的优点。
Glisson 入路对于 MIALR 是安全可行的，与传统肝门入路相比具有多项优势。明确了解 Laennec 囊解剖结构是必要的，可作为解剖的指导。然而，要进行的最佳手术入路取决于外科医生的经验和患者的特征。MIALR 中 Glisson 入路的标准化很重要。
